Volume 9; Number 6 May 2015 PRESCRIBING FOR CHRONIC OPEN ANGLE GLAUCOMA (COAG) AND OCULAR HYPERTENSION (OHT)
|
|
- Violet McDaniel
- 5 years ago
- Views:
Transcription
1 Greater East Midlands Commissioning Support Unit in association with Lincolnshire Clinical Commissioning Groups, Lincolnshire Community Health Services, United Lincolnshire Hospitals Trust and Lincolnshire Partnership Foundation Trust Volume 9; Number 6 May 2015 PRESCRIBING FOR CHRONIC OPEN ANGLE GLAUCOMA (COAG) AND OCULAR HYPERTENSION (OHT) Key Points This review of existing guidance has been necessitated by the introduction of lower cost generic preparations and new products and the discontinuation of some existing product lines. Treatment for should be initiated by a secondary care based ophthalmologist, although ongoing prescribing may be undertaken by a GP or non-medical prescriber. As a result of this, all of the products recommended for use are designated. Wherever possible, eye preparations should be prescribed as multi-dose containers. Preservative free formulations are considerably more expensive than multi-dose equivalents and should be reserved for use in patients with genuine cases of hypersensitivity to the preservative or following corneal transplant surgery. Prostaglandin analogue eye preparations (PGAs): first line for patients newly diagnosed with mild to moderate COAG. NICE recommend that all people newly diagnosed with early or moderate chronic open angle glaucoma (COAG) and at risk of significant visual loss in their lifetime should be offered a prostaglandin analogue (PGA) eye preparation. A recently published meta-analysis has concluded that bimatoprost, latanoprost and travoprost produce similar reductions in intra-ocular pressure (IOP), although there is some variation in the incidence of key adverse reactions. Lower cost generic latanoprost 50mcg per ml eye drops (2.5ml bottle) are the preferred first line option in people with glaucoma or raised intraocular pressure (IOP), particularly in those with early, mild disease. Prescribers are urged to ensure that all prescribing of latanoprost 50mcg per ml eye drops is generic. At present, brand name prescribing of Xalatan 50mcg per ml eye drops is causing an unnecessary additional cost across Lincolnshire of 36,700pa (see text for individual CCG figures). Second line options for those who have failed to achieve the desired reduction in IOP with latanoprost or who are unable to tolerate the product are either travoprost 40microgram per ml (Travatan) or third line for new patients bimatoprost 100mcg per ml (Lumigan). 1
2 In view of the imminent discontinuation of bimatoprost 300mcg per ml eye drops (Lumigan), prescribers are encouraged to identify all patients currently using this strength with a view to switching them to bimatoprost 100mcg per ml eye drops (Lumigan). The manufacturer, Allergan, has produced published evidence confirming equivalent effectiveness between the two strengths. The licensed dose of bimatoprost 100mcg per ml eye drops (Lumigan) is one drop daily into the affected eye. Bimatoprost 300mcg per ml eye drops (Lumigan) have been removed from the Lincolnshire Joint Formulary and replaced by the 100mcg per ml strength; designation. The higher price of the 100mcg per ml strength will increase Lincolnshire prescribing costs by 38,700 (see text for individual CCG impact. Where a preservative-free preparation is indicated, latanoprost 50mcg per ml (Monoprost) should be preferred; designation. Both preservative-free bimatoprost 300mcg per ml drops (Lumigan) and preservative-free tafluprost 15mcg per ml drops (Saflutan) are also included in the Lincolnshire Joint Formulary and designated to enable flexibility in patients insufficiently responsive to or intolerant of latanoprost. Second line alternatives (1) Beta-blockers For early to moderate COAG, NICE recommend that PGAs should be considered first line; if the target reduction in IOP is not achieved with the first PGA, a second should be considered or PGA/beta-blocker (BB) combination therapy. If the target IOP is still not achieved, PGA/BB/carbonic anhydrase inhibitor combination therapy should be considered. Generic timolol 0.25% and 0.5% eye drops are approved as the first line BBs of choice; both products are designated. Betaxolol 0.25% and 0.5% eye drops (Betoptic) and levobunolol 0.5% eye drops (generic/betagan) are approved as second line alternatives to timolol and are also designated. Where a once daily timolol eye preparation is indicated, timolol 0.25% and 0.5% gel forming solution (Timoptol-LA) is approved as. Preservative-free single-dose preparations of timolol, betaxolol and levobunolol are also approved for use in genuine cases of hypersensitivity to the preservative or following corneal transplant surgery; designation AMBER without shared care (see text). (2) Prostaglandin analogue/beta-blocker combination products Bimatoprost 300mcg/ timolol 5mg per ml eye drops (Ganfort), latanoprost 50mcg/ timolol 5mg per ml eye drops (generic) and travoprost 40mcg/ timolol 5mg per ml drops (DuoTrav) are all approved for use on the Lincolnshire Joint Formulary; designation. Latanoprost 50mcg/ timolol 5mg per ml eye drops should always be prescribed generically, not as Xalacom. Where a combination PGA/BB preparation is indicated, local ophthalmologists prefer bimatoprost 300mcg/ timolol 5mg per ml eye drops (Ganfort) and travoprost 40mcg/ timolol 5mg per ml drops (DuoTrav). Combination PGA/BB preparations should usually be administered in the evening. When adding a BB to a PGA, select the combination product containing the same PGA as previously prescribed as monotherapy unless this was not tolerated. 2
3 (3) Carbonic anhydrase inhibitors (CAIs) Dorzolamide 2% eye drops are now available generically at a significantly lower cost than either branded Trusopt or brinzolamide 1% eye drops (Azopt). However, as dorzolamide 2% eye drops are formulated at a lower ph than brinzolamide, they can be more irritant to the eye causing an unpleasant stinging sensation on application. As a result of this, despite the lower cost of generic dorzolamide, both products are approved for inclusion in the Lincolnshire Joint Formulary as possible first line options; designation AMBER without shared care. Prescribers should ensure that all remaining prescriptions for the Trusopt brand of dorzolamide 2% eye drops are genericised. The single dose preservative-free formulation of dorzolamide (Trusopt) should only be used in genuine cases of hypersensitivity to the preservative or following corneal transplant surgery. (4) Carbonic anhydrase inhibitor/beta blocker combinations When adding a BB to a CAI, select the combination product containing the same CAI as previously received as monotherapy unless this was not tolerated. The emergence of lower cost generic dorzolamide 2% eye drops and dorzolamide 2%/timolol 0.5% eye drops means that dorzolamide containing preparations should be considered as first line alternatives to brinzolamide 1% eye drops (Azopt) and brinzolamide 1%/ timolol 0.5% eye drops (Azarga). Both dorzolamide 2%/timolol 0.5% drops (generic) and brinzolamide 1%/timolol 0.5% drops (Azarga) are approved for use through the Lincolnshire Joint Formulary and designated. Prescribers should ensure that all remaining prescriptions for the Cosopt brand of dorzolamide 2%/timolol 0.5% eye drops are genericised. The single dose preservative free formulation of Cosopt is also designated, but should only be used in genuine cases of hypersensitivity to the preservative or following corneal transplant surgery. (5) Alpha 2 agonists Local ophthalmologist advice is that alpha 2 agonists should be considered as primary treatment for those patients who are non-responders or are allergic to both PGAs and CAIs. They should also be considered as a third medication for patients who have partly responded to treatments with PGAs and CAIs but who decline surgery or in whom surgery is contraindicated. Generic brimonidine 0.2% eye drops are the preferred alpha 2 agonist eye preparation and are designated. Prescribers should ensure that all remaining prescriptions for the Alphagan brand of brimonidine 0.2% eye drops are genericised. Apraclonidine 0.5% solution (Iopidine) is also designated AMBER without shared care, but should only be used short-term (a maximum of one month) as an adjunctive treatment of chronic glaucoma to delay laser treatment or glaucoma surgery in patients not adequately controlled with other treatments. (6) Carbonic anhydrase inhibitors/ alpha 2 agonist combination products The new carbonic anhydrase inhibitor/ alpha 2 agonist combination product Simbrinza eye drops (Brinzolamide 1%/brimonidine 0.2%) should only be used for those patients unable to tolerate alternative combination therapies such as PGA/BBs or CAI/BBs. 3
4 (7) Alpha 2 agonists/ beta-blocker combination The alpha 2 agonist/bb combination preparation Combigan should only be used for those patients unable to tolerate prostaglandin analogues and carbonic anhydrase inhibitors when treatment with a beta-blocker alone is not adequate. Brimonidine 0.2%/timolol 0.5% eye drops (Combigan) is designated. (8) Systemic treatments (oral carbonic anhydrase inhibitors) Acetazolamide 250mg tablets (Diamox) and sustained release capsules (Diamox SR) are recommended for short term use only as an adjunct to other treatments in people with raised IOP. Oral carbonic anhydrase inhibitors are not recommended for long term use as they can cause agranulocytosis, thrombocytopenia, electrolyte disturbances and metabolic acidosis. Regular monitoring of full blood count and plasma electrolyte count is recommended. Both products are designated for this indication. SUMMARY OF PACEF DECISIONS: MARCH 2015 Prostaglandin analogue eye preparations (PGAs): first line for patients newly diagnosed with mild to moderate COAG. First Line Latanoprost 50mcg per ml drops (generic) (2.5ml bottle) Second Line Bimatoprost 100mcg/ml eye drops (Lumigan) (3ml bottle) Travoprost 40mcg per ml drops (Travatan) (2.5ml bottle) Second line alternatives Beta-blockers 1st line for those with early or mild disease. 2nd line for those who have failed to achieve the desired reduction in IOP with latanoprost or who cannot tolerate latanoprost 2nd line for those who have failed to achieve the desired reduction in IOP with latanoprost or who cannot tolerate latanoprost Beta Blocker Eye Preparations First Line Timolol 0.25% and 0.5% eye drops (generic) (5ml bottle) Timoptol LA 0.25% and 0.5% gel forming eye drops (2.5ml bottle) Second Line Betaxolol 0.25% and 0.5% eye drops (Betoptic) (5ml bottle) Levobunolol 0.5% eye drops (generic/betagan) (5ml bottle) secondary glaucoma secondary glaucoma 1st line BB eye preparation of choice. Amber without shared care Once daily multi-dose preparation Second line BB after timolol eye drops Second line BB after timolol eye drops Prostaglandin analogue/beta-blocker combination products Latanoprost 0.005%/ timolol 0.5% eye drops (generic) insufficiently responsive to BBs or prostaglandin analogues. Prescribe generically and not as the higher cost branded preparation Xalacom. 4
5 Bimatoprost 300mcg/ timolol 5mg per ml eye drops (Ganfort) (3ml bottle) Travoprost 40mcg/ timolol 5mg per ml drops (DuoTrav) (2.5ml bottle) insufficiently responsive to BBs or prostaglandin analogues insufficiently responsive to BBs or prostaglandin analogues Carbonic anhydrase inhibitors Brinzolamide 1% drops (Azopt) Monotherapy where BBs are (5ml bottle) ineffective or contra-indicated or as Dorzolamide 2% eye drops (generic) an adjunct to BBs in Monotherapy where BBs are ineffective or contra-indicated or as an adjunct to BBs in OHT, COAG or pseudo-exfolliative glaucoma Carbonic anhydrase inhibitors/beta-blocker combination products Prescribe generically and not as the higher cost branded preparation Trusopt. Brinzolamide 1%/ timolol 0.5% eye Raised intraocular pressure in drops (Azarga) where monotherapy Dorzolamide 2%/ timolol 0.5% eye drops (generic) Alpha 2 agonists is inadequate Raised intraocular pressure in where monotherapy is inadequate Prescribe generically and not as the higher cost branded preparation Cosopt. Brimonidine 0.2% eye drops (generic) Apraclonidine 0.5% solution (Iopidine) as monotherapy where BBs are contraindicated or as adjunct to other agents when target IOP is not achieved with a single agent Short-term adjunctive treatment of chronic glaucoma to delay laser treatment or glaucoma surgery Carbonic anhydrase inhibitors/ alpha 2 agonist combination products Alpha 2 agonist eye preparation of choice Should only be used short-term (a maximum of one month) as an adjunctive treatment of chronic glaucoma to delay laser treatment or glaucoma surgery in patients not adequately controlled with other treatments. Brinzolamide 10mg/brimonidine 2mg (Simbrinza) Reduction in IOP in insufficiently responsive to monotherapy Should only be used for those patients unable to tolerate alternative combination therapies such as prostaglandin analogues/ betablockers or carbonic anhydrase inhibitors/ beta blockers. Alpha 2 agonists/ beta-blocker combination Brimonidine 0.2%/timolol 0.5% eye drops (Combigan) Reduction in IOP in insufficiently responsive to topical BBs Systemic treatments (oral carbonic anhydrase inhibitors) 5. Should only be used for those unable to tolerate PGAs and CAIs when treatment with a BB alone is not adequate.
6 Acetazolamide tablets 250mg (Diamox) Acetazolamide capsules MR 250mg (Diamox SR) Reduction of IOP in COAG, and perioperatively in angle closure glaucoma Reduction of IOP in COAG, and perioperatively in angle closure glaucoma. For short term use only as an adjunct to other treatments in people with raised IOP.. For short term use only as an adjunct to other treatments in people with raised IOP. This bulletin has been created specifically to convey details of decisions taken at the Prescribing and Clinical Effectiveness Forum (PACEF) to all stakeholders across the Lincolnshire Healthcare Community in both primary and secondary care. Back issues of the PACE Bulletin and other PACEF publications are available through the PACEF website ( follow the commissioning link to PACEF. Electronic copies of the PACE Bulletin are circulated to a wide readership via . If you are not currently on our distribution list and wish to receive regular copies of PACEF publications please contact Sandra France on sandra.france@gemcsu.nhs.uk. Google searching can be a quick and effective way of finding back numbers of the PACE Bulletin relevant to a specific topic of interest. Searchers are advised to use the official version of the Bulletin available from the PACEF website rather than depend on a potentially unreliable draft or variant found through Google or an alternative search engine. The Lincolnshire Joint Formulary is available on line and is fully searchable; it can be accessed at THIS DOCUMENT IS INTENDED FOR USE BY NHS HEALTHCARE PROFESSIONALS ONLY AND CANNOT BE USED FOR COMMERCIAL OR MARKETING PURPOSES WITHOUT PERMISSION. Introduction In May 2010 PACEF issued guidance on the treatment of chronic open angle glaucoma (COAG) and ocular hypertension (OHT) (see PACE Bulletin Vol 4 No 6 (May 2010)). Many of the recommendations were drawn from NICE Clinical Guideline 85, Glaucoma: Diagnosis and management of chronic open angle glaucoma and ocular hypertension (April 2009). This guidance has now been reviewed and updated in collaboration with ophthalmologists from United Lincolnshire Hospitals. The review was necessitated by the introduction of lower cost generic preparations and new products and the discontinuation of some existing product lines. General principles Treatment for should be initiated by a secondary care based ophthalmologist, although ongoing prescribing may be undertaken by a GP or nonmedical prescriber. As a result of this, all of the products recommended for use are designated. Wherever possible, eye preparations should be prescribed as multi-dose containers. Preservative free formulations are considerably more expensive than multi-dose equivalents and should be reserved for use in patients with genuine cases of hypersensitivity to the preservative or following corneal transplant surgery. First line treatments: Prostaglandin analogues (PGAs) NICE recommend that all people newly diagnosed with early or moderate chronic open angle glaucoma (COAG) and at risk of significant visual loss in their lifetime should be offered a prostaglandin analogue (PGA) eye preparation (see NICE Clinical Guideline 85). The currently available products including licensed indications, doses and comparative costs are tabulated below: Prostaglandin analogue Licensed indications Recommended dose Cost Bimatoprost 0.1mg per ml As monotherapy or as 3ml drops (Lumigan) an adjunct to BBs in Bimatoprost 0.3mg per ml As monotherapy or as 3ml
7 drops (Lumigan) Bimatoprost 0.3mg per ml drops (preservative-free; single dose) Latanoprost 50mcg per ml drops (generic) Latanoprost 50mcg per ml drops (Xalatan) Latanoprost 50mcg/ml drops (Monopost) (preservative-free; single dose) Tafluprost 15mcg per ml drops (Saflutan) (preservative-free; single dose) Travoprost 40mcg per ml drops (Travatan) an adjunct to BBs in As monotherapy or as an adjunct to BBs in As monotherapy or as an adjunct to BBs in Discontinued (30) 2.5ml ml (30) (90) (30) 2.5ml Latanoprost, tafluprost and travoprost are all PGAs; bimatoprost is a prostamide analogue. All of these agents work by increasing uveoscleral outflow resulting in reductions in intraocular pressure (IOP) of between 25 and 35%. PGAs can cause darkening of the iris in 5 to 20% of patients. As a result of this, PGA treatment should normally be reserved for those receiving treatment for both eyes. Where uniocular use is being considered, the patient should be informed of this risk and consent to treatment recorded their medical notes. If only one eye is affected, alternative first-line treatments include either a carbonic anhydrase inhibitor or, if there are no contraindications, a beta-blocker (see below). In addition, all PGAs can also cause conjunctival hyperaemia (red eye) and hypertrichosis of the eyelashes (prolific growth). Patients receiving treatment with PGAs should be monitored for any changes to growth of lashes and eye colouration. PGAs should not be used in women of child bearing potential unless adequate contraceptive measures are in place. If PGAs need to be used in pregnancy, the prescriber should ensure that the patient is fully informed of the potential risks if they become pregnant. Such patients should be advised to seek advice from either their GP or ophthalmologist if they decide to discontinue contraceptive use or if they suspect they have become pregnant. A recently published meta-analysis has concluded that bimatoprost, latanoprost and travoprost produce similar reductions in IOP, although there is some variation in the incidence of key adverse reactions. Generic latanoprost 50mcg per ml drops Latanoprost 50mcg per ml drops are now available as a generic preparation and emerge from the cost comparison as significantly lower in price than any of the alternative PGAs. PACEF Recommendation: Lower cost generic latanoprost 50mcg per ml eye drops (2.5ml bottle) are the preferred first line option in people with glaucoma or raised intraocular pressure (IOP), particularly in those with early, mild disease. Prescribers are urged to ensure 7
8 that all prescribing of latanoprost 50mcg per ml eye drops is generic. At present, brand name prescribing of Xalatan 50mcg per ml eye drops is causing an unnecessary additional cost across Lincolnshire of 36,700pa (LECCG 6,539, LWCCG 16,936, SLCCG 6,581 and SWLCCG 6,707). PACEF Recommendation: Second line options for those who have failed to achieve the desired reduction in IOP with latanoprost or who are unable to tolerate the product are either travoprost 40mcg per ml (Travatan) or third line for new patients bimatoprost 100mcg per ml (Lumigan). Discontinuation of bimatoprost 300mcg per ml drops (Lumigan) Allergan have recently announced their intention to discontinue bimatoprost 300mcg per ml drops multidose eye drops (Lumigan) by the end of April Patients currently receiving bimatoprost 300mcg/ml multidose eye drops will need to be switched to an alternative product. In the absence of a directly equivalent preparation, this will necessitate the switching of patients to the lower strength bimatoprost 100mcg per ml drops. The recommended dose should be one drop daily. Allergan have stated that there is published evidence confirming comparable effectiveness between the 100mcg/ml and 300mcg/ml strengths of Lumigan. PACEF reviewed a noninferiority study five years ago when the lower strength product was first launched. This study compared the efficacy and adverse effects of three strengths of bimatoprost 100mcg/ml, 125mcg/ml (unlicensed) and 300mcg/ml (see PACE Bulletin Vol 4 No 14). In addition to comparable efficacy, a lower incidence of side effects was reported with the lower strength. When evaluating this study, PACEF were concerned about the differences in efficacy between the three strengths and were particularly concerned that an intermediate strength (125mcg/ml) appeared to be less effective than both the 100mcg/ml and the 300mcg/ml. These concerns, in addition to the higher cost of the 100mcg/ml strength resulted in bimatoprost 100mcg per ml drops (Lumigan) being initially designated RED/RED. The discontinuation of the 300mcg/ml strength has led to this decision being over-turned and bimatoprost 100mcg/ml eye drops (Lumigan) are now designated AMBER without shared care. The ULHT ophthalmology service has confirmed that the majority of patients currently receiving treatment with bimatoprost 300mcg per ml eye drops will have already received treatment with at least one other PGA (either latanoprost or travoprost). This means that, when bimatoprost 300mcg per ml eye drops are withdrawn, bimatoprost 100mcg per ml eye drops will be the most appropriate alternative for most patients. There is a difference in the concentration of the preservative benzalkonium chloride (BAC) between the higher and lower strengths of bimatoprost. Bimatoprost 100mcg/ml contains 0.2mg/ml BAC (the same concentration as that found in latanoprost formulations) whereas the higher strength product had a lower concentration of BAC, 0.05mg/ml. If patients do not tolerate the preservative content of the eye drop, standard advice is to consider a preservative-free product. PACEF Recommendation: In view of the discontinuation of bimatoprost 300mcg per ml eye drops (Lumigan), prescribers are encouraged to identify all patients currently using this strength with a view to switching them to bimatoprost 100mcg per ml eye drops (Lumigan). The licensed dose of bimatoprost 100mcg/ml is one drop daily into each affected eye. Bimatoprost 300mcg per ml eye drops (Lumigan) are to be removed from the Lincolnshire Joint Formulary and replaced by the 100mcg per ml strength; 8
9 designation. The higher price of the 100mcg per ml strength will increase Lincolnshire prescribing costs by 38,700 (LECCG 15,488, LWCCG 5,674, SLCCG 13,187 and SWLCCG 4,354). Preservative- free formulations (single use only) Prostaglandin analogue Licensed indications Recommended dose Cost Bimatoprost 300mcg per ml drops (Lumigan) (preservative-free; single dose) As monotherapy or as an adjunct to BBs in (30) Latanoprost 50mcg/ml drops (Monopost) (preservative-free; single dose) Tafluprost 15mcg per ml drops (Saflutan) (preservative-free; single dose) As monotherapy or as an adjunct to BBs in (30) (90) (30) PACEF Recommendations Preservative free formulations should only be used in genuine cases of hypersensitivity to the preservative or following corneal transplant surgery. Whilst, the preservative-free formulation of latanoprost 50mcg per ml eye drops (Monoprost) is considerably more expensive than generic latanoprost 50mcg per ml eye drops it is less costly than the multi-dose formulations of bimatoprost 100mcg per ml and travoprost 15mcg per ml (see table above). Where a preservative-free preparation is indicated, latanoprost 50mcg per ml (Monoprost) should be preferred; designation. Both preservative-free bimatoprost 300mcg per ml drops (Lumigan) and preservative-free tafluprost 15mcg per ml drops (Saflutan) are also included in the Lincolnshire Joint Formulary and designated to enable flexibility in patients insufficiently responsive to or intolerant of latanoprost. Second line treatments For early to moderate COAG, NICE recommend that PGAs should be considered first line; if the target reduction in IOP is not achieved with the first PGA, a second should be considered or PGA/beta-blocker (BB) combination therapy. If the target IOP is still not achieved, PGA/BB/carbonic anhydrase inhibitor combination therapy should be considered. (1) Beta-blockers (BBs) BBs should be used in accordance with the NICE Clinical Guidelines as outlined above. In newly diagnosed cases of early or moderate COAG where only one eye is affected, a BB (if there are no contraindications) or a carbonic anhydrase inhibitor should be considered as first line alternatives. The currently available products, licensed indications, doses and comparative costs are tabulated below: Beta-Blockers Licensed indications Recommended dose Cost Betaxolol 0.25% eye drop suspension (Betoptic Suspension) 5ml 2.66 Betaxolol 0.5% eye drops (Betoptic Solution) 5ml 1.90 Betaxolol 0.25% 50 x 0.25ml 13.77
10 suspension single dose vials preservative-free (Betoptic Suspension) Carteolol 1% eye drops (Teoptic) Carteolol 2% eye drops (Teoptic) Levobunolol 0.5% drops (generic) Levobunolol 0.5% drops (Betagan) Levobunolol 0.5% preservative-free singleuse eye drops (Betagan) Timolol 0.25% eye drops (generic) Timolol 0.5% eye drops (generic) Timolol 0.25% eye drops (Timoptol) Timolol 0.25% solution in preservative-free unit dose vials (Timoptol) Timolol 0.5% eye drops (Timoptol) Timolol 0.5% solution in preservative-free unit dose vials (Timoptol) Timolol 0.25% gelforming eye drops (Timoptol LA) Timolol 0.5% gel-forming eye drops (Timoptol LA) Timolol 0.1% preservative-free single use ophthalmic gel (Tiopex) some s some s affected eye once or twice daily affected eye once or twice daily affected eye once or twice daily One drop in the affected eye(s) daily, preferably in the morning 5ml ml ml ml x 0.4ml ml ml ml x 0.2ml ml x 0.2ml ml ml x 0.4g 7.49 BB eye drop formulations reduce IOP by approximately 25%. BBs are contra-indicated in bradycardia, heart block or uncontrolled heart failure. The Committee on Safety of Medicines has advised that BBs, even those with apparent cardio-selectivity, should not be used in patients with asthma or a history of obstructive airways disease, unless no alternative treatment is available. In such cases, appropriate precautions should be taken to reduce the risk of inducing bronchospasm. Betaxolol is more cardioselective than timolol, but seems to be less effective. PACEF Recommendations Generic timolol 0.25% and 0.5% eye drops are approved as the first line BBs of choice; both products are designated. Timolol 0.25% and 0.5% solution in preservative-free unit dose vials (Timoptol) is also designated, but should only be used in genuine cases of hypersensitivity to the preservative or following corneal transplant surgery. Betaxolol 0.25% and 0.5% eye drops (Betoptic) and levobunolol 0.5% eye drops (generic/betagan) are approved as second line alternatives to timolol and are designated. Preservative free betaxolol 0.25% suspension (Betoptic) and levobunolol 0.5% preservative-free single-use eye drops 10
11 (Betagan) are also approved as in genuine cases of hypersensitivity to the preservative or following corneal transplant surgery. Where a once daily timolol eye preparation is indicated, timolol 0.25% and 0.5% gel forming solution (Timoptol-LA) is approved as ; a timolol 0.1% preservative free gel (Tiopex) is also approved in genuine cases of hypersensitivity to the preservative or following corneal transplant surgery, designated. Carteolol 1% and 2% eye drops (Teoptic) are prohibitively expensive and should not be prescribed; designation RED-RED. (2) Prostaglandin analogue/beta-blocker combination products Combination preparations can help to improve adherence by reducing the number of preparations and doses. PGA/BB combination Indication(s) Recommended dose Cost Bimatoprost 300mcg/ timolol 5mg per ml eye drops (Ganfort) (3ml bottle) insufficiently responsive to BBs or prostaglandin analogues in the morning or evening Latanoprost 50mcg/ timolol 5mg per ml eye drops (generic) Latanoprost 50mcg/ timolol 5mg per ml eye drops (Xalacom) Travoprost 40mcg/ timolol 5mg per ml drops (DuoTrav) insufficiently responsive to topical BBs or prostaglandin analogues insufficiently responsive to BBs or prostaglandin analogues insufficiently responsive to BBs or prostaglandin analogues in the morning or evening 3ml x 3ml ml ml x 2.5ml ml Patent expiry: August Unless otherwise stated, combination PGA and BB preparations should be administered in the evening. When adding a BB to a PGA, select the combination product containing the same PGA as previously prescribed as monotherapy unless this was not tolerated. In line with formulary recommendations for the use of prostaglandin analogues and beta blockers, preparations containing latanoprost, bimatoprost and travoprost in combination with timolol are all included on the Joint Formulary, designated. Based on limited evidence from a small (n=195) single study, it is possible that the use of latanoprost and timolol in a combination preparation is not as effective as using the two components prescribed separately. A 12 week randomised multi-centered study published in the British Journal of Ophthalmology in 2004 compared the IOP lowering effect and safety of a fixed dose once daily latanoprost and timolol combination with the concomitant use of the individual components. Results showed that after 12 weeks there was a difference in mean diurnal IOP levels between the fixed combination and the separate components of 1.1mmHg, favouring the separate components. The primary endpoint of the study of noninferiority of the combination product compared to the individual components was not reached. It is possible that this can be explained by the fact that patients on the fixed dose combination administered their dose in the morning, whereas those on the separate components administered the latanoprost component. Previous published evidence has suggested that latanoprost is more effective if administered. It is also possible that patient s benefited from the additional dose of timolol in separate component therapy where twice daily dosing may have contributed to a further reduction in IOP. 11
12 PACEF Recommendations: Bimatoprost 300mcg/ timolol 5mg per ml eye drops (Ganfort), latanoprost 50mcg/ timolol 5mg per ml eye drops (generic) and travoprost 40mcg/ timolol 5mg per ml drops (DuoTrav) are all approved for use on the Lincolnshire Joint Formulary; designation. Latanoprost 50mcg/ timolol 5mg per ml eye drops should always be prescribed generically, not as Xalacom. Where a combination PGA/BB preparation is indicated local ophthalmologists prefer bimatoprost 300mcg/ timolol 5mg per ml eye drops (Ganfort) and travoprost 40mcg/ timolol 5mg per ml drops (DuoTrav). (3) Carbonic anhydrase inhibitors (CAIs) If after adding a BB to a PGA, clinical response remains insufficient a carbonic anhydrase inhibitor should be considered. Also, newly diagnosed cases of early or moderate COAG where only one eye is affected may be better treated first line with either a CAI or a BB (if there are no contraindications). The currently available CAI containing products, including licensed indications, doses and comparative costs are tabulated below: Carbonic anhydrase inhibitors Brinzolamide 1% eye drops (Azopt) Dorzolamide 2% eye drops (generic) Dorzolamide 2% eye drops (Trusopt) Dorzolamide 2% preservative free single use eye drops (Trusopt) Licensed indications Recommended dose Cost Monotherapy where BBs are ineffective or contraindicated or as an adjunct to BBs in COAG or OHT Monotherapy where BBs are ineffective or contraindicated or as an adjunct to BBs in OHT, COAG or pseudoexfolliative glaucoma Monotherapy where BBs are ineffective or contraindicated or as an adjunct to BBs in OHT, COAG or pseudoexfolliative glaucoma Monotherapy where BBs are ineffective or contraindicated or as an adjunct to BBs in OHT, COAG or pseudoexfolliative glaucoma affected eye two or three times a affected eye two or three times a affected eye two or three times a affected eye two or three times a 5ml 6.92 Patent expired: Dec ml ml x 0.2ml Carbonic anhydrase inhibitor (CAI) eye preparations containing either brinzolamide or dorzolamide lower IOP by approximately 20%. PACEF Recommendations: Dorzolamide 2% eye drops are now available generically at a significantly lower cost than either branded Trusopt or brinzolamide 1% eye drops (Azopt). However, as dorzolamide 2% eye drops are formulated at a lower ph than brinzolamide, they can be more irritant to the eye causing an unpleasant stinging sensation on application. As a result of this, despite the lower cost of generic dorzolamide, both products are approved for inclusion in the Lincolnshire Joint Formulary as possible first line options; designation. The single dose preservative free formulation of dorzolamide (Trusopt) is also designated as, but should only be used in genuine cases of hypersensitivity to the preservative or following corneal transplant surgery. 12
13 (4) Carbonic anhydrase inhibitor/beta blocker combinations Carbonic anhydrase inhibitor/beta blocker combination Brinzolamide 1%/ timolol 0.5% eye drops (Azarga) Dorzolamide 2%/timolol 0.5% eye drops (generic) Dorzolamide 2%/ timolol 0.5% eye drops (Cosopt) Dorzolamide 2%/ timolol 0.5% drops preservativefree single use eye drops (Cosopt) Licensed indications Recommended dose Cost Raised intraocular pressure in COAG or OHT where monotherapy is inadequate Raised intraocular pressure in COAG or OHT where monotherapy is inadequate Raised intraocular pressure in COAG or OHT where monotherapy is inadequate Raised intraocular pressure in COAG or OHT where monotherapy is inadequate 5ml ml ml x 0.2ml PACEF Recommendations: When adding a BB to a CAI, select the combination product containing the same CAI as previously received as monotherapy unless this was not tolerated. The emergence of lower cost generic dorzolamide 2% eye drops and dorzolamide 2%/timolol 0.5% eye drops means that dorzolamide containing preparations should be considered as first line alternatives to brinzolamide 1% eye drops (Azopt) and brinzolamide 1%/ timolol 0.5% eye drops (Azarga). Lower cost generic dorzolamide 2%/ timolol 0.5% eye drops have already generated fortuitous savings across the county of nearly 70,000pa. A further 28,000pa cost reduction could be achieved by prescribing all dorzolamide 2%/ timolol 0.5% eye drops generically. Both dorzolamide 2%/timolol 0.5% drops (generic) and brinzolamide 1%/timolol 0.5% drops (Azarga) are approved for use through the Lincolnshire Joint Formulary and designated AMBER without shared care. The single dose preservative free formulation of Cosopt is also designated,, but should only be used in genuine cases of hypersensitivity to the preservative or following corneal transplant surgery. (5) Alpha 2 agonists In general, alpha 2 agonists are less effective at lowering IOP than PGAs. The range of products available, including licensed indications, doses and prices are tabulated below: Alpha 2 agonists Licensed indication Dose Price Apraclonidine 0.5% eye 5ml drops (Iopidine) Apraclonidine 1.0% preservative-free singleuse eye drops (Iopidine) Brimonidine 0.2% eye drops (generic) Short-term adjunctive treatment of chronic glaucoma to delay laser treatment or glaucoma surgery Short-term adjunctive treatment of chronic glaucoma to delay laser treatment or glaucoma surgery as monotherapy where BBs are contraindicated or as 13 affected eye three times a affected eye three times a 24 x 0.25ml ml 2.26
14 Brimonidine 0.2% eye drops (Alphagan) adjunct to other agents when target IOP is not achieved with a single agent as monotherapy where BBs are contraindicated or as adjunct to other agents when target IOP is not achieved with a single agent 5ml 6.85 Local ophthalmologist advice is that alpha 2 agonists should be considered as primary treatment for patients who are non-responders or are allergic to both PGAs and CAIs. They should also be considered as a third medication for patients who have partly responded to treatments with PGAs and CAIs but who decline surgery or in whom surgery is contraindicated. PACEF Recommendations Generic brimonidine 0.2% eye drops are the preferred alpha 2 agonist eye preparation and are designated. The patent expiry of brimonidine 0.2% eye drops (Alphagan) has already generated fortuitous savings of 34,000pa across the county as generic prices have fallen. Additional savings could be achieved by ensuring that all remaining prescriptions for Alphagan are genericised. Apraclonidine 0.5% solution (Iopidine) is also designated AMBER without shared care, but should only be used short-term (a maximum of one month) as an adjunctive treatment of chronic glaucoma to delay laser treatment or glaucoma surgery in patients not adequately controlled with other treatments. Alpha 2 agonists/ beta-blocker combination Alpha 2 agonists/betablocker Brimonidine 0.2%/ timolol 0.5% eye drops (Combigan) Licensed indication Dose Price Reduction in IOP in insufficiently responsive to topical BBs 5ml x5ml PACEF Recommendations The alpha 2 agonist/bb combination preparation Combigan should only be used for those patients unable to tolerate prostaglandin analogues and carbonic anhydrase inhibitors when treatment with a beta-blocker alone is not adequate. Brimonidine 0.2%/timolol 0.5% eye drops (Combigan) is designated. Carbonic anhydrase inhibitors/ alpha 2 agonist combination There is a new CAI/alpha 2 agonist combination product containing brinzolamide 1% and brimonidine 0.2% launched under the brand name Simbrinza. Key information is tabulated below: Carbonic anhydrase inhibitor/alpha 2 agonists Brinzolamide 1%/brimonidine 0.2% eye drops (Simbrinza) Licensed indication Dose Price Reduction in IOP in insufficiently responsive to monotherapy. 5ml
15 PACEF Recommendations Simbrinza should only be used for those patients unable to tolerate alternative combination therapies (i.e prostaglandin analogue/ beta-blocker or carbonic anhydrase inhibitor/ beta blocker). Systemic treatments Acetazolamide 250mg tablets (Diamox) and 250mg sustained release capsules (Diamox SR) are recommended for short term use as an adjunct to other treatments in people with raised IOP. Oral carbonic anhydrase inhibitors are not recommended for long term use as they can cause agranulocytosis, thrombocytopenia, electrolyte disturbances and metabolic acidosis. Regular monitoring of full blood count and plasma electrolyte count is recommended. Acetazolamide is contraindicated in those patients with a history of allergy to sulphonamides., PACEF Recommendation Both acetazolamide 250mg tablets (Diamox) and sustained release capsules (Diamox SR) are designated for short-term use within licensed indications. References British National Formulary, 68 (September 2014 March 2015) Diestelhorst M, Larsson L-I on behalf of lantanoprost fixed combination study group, A 12 week study comparing the fixed combination of latanoprost and timolol with the concomitant use of the individual components in patients with open angle glaucoma and ocular hypertension [British Journal of Ophthalmology. 2004;88: ) Eyawo O et al., Efficacy and safety of PGAs in patients with predominantly primary open-angle glaucoma or OHT: a meta-analysis, Clinical Ophthalmology 2009: 3: MIMS, March NICE Clinical Guideline 85, Glaucoma: Diagnosis and management of chronic open angle glaucoma and ocular hypertension (April 2009). PACE Bulletin Volume 4, Number 14 (September 2010), Rapid Drug Assessment: Bimatoprost 0.01% eye drops (Lumigan) Treatment of open-angle glaucoma, Clinical Pharmacist, 2, March Acknowledgements This guidance has been prepared with the help of Mr Mohit Gupta Consultant Ophthalmologist and Clinical Director Head and Neck pan trust for United Lincolnshire Hospitals. THIS DOCUMENT IS INTENDED FOR USE BY NHS HEALTHCARE PROFESSIONALS ONLY AND CANNOT BE USED FOR COMMERCIAL OR MARKETING PURPOSES WITHOUT PERMISSION. Cathy Johnson Interface Lead Pharmacist (Lincolnshire) Arden and Greater East Midlands Commissioning Support Unit Stephen Gibson Head of Prescribing and Medicines Optimisation (Lincolnshire) Arden GEM CSU May
South East London Area Prescribing Committee Chronic Open Angle Glaucoma and Ocular Hypertension Treatment Pathway
Proceed to 2 nd line treatment if further reduction in IOP required and there is good response to PGAs or (& no South East London Area Prescribing Committee Chronic Open Angle Glaucoma and Ocular Hypertension
More informationDERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC)
Guidelines for the medical treatment of chronic open angle glaucoma and ocular hypertension Summary: DERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC) Diagnosis and management of ocular hypertension (OHT)
More informationVolume 4; Number 6 May 2010
Volume 4; Number 6 May 2010 What s new this month: Local ophthalmologists have been working with PACEF to develop a formulary of eye preparations for the treatment of open angle and raised intra ocular
More informationThe legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION. 28 May 2008
The legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION 28 May 2008 COSOPT 20 mg/5 mg/ml, eye drops, solution in single dose container Box of 60 0.2 ml single dose containers
More informationEast and North Hertfordshire treatment pathway for primary open angle glaucoma and ocular hypertension in adults
East and North Hertfordshire treatment pathway for primary open angle glaucoma and ocular hypertension in adults Introduction Glaucoma is a group of eye diseases causing optic nerve damage. In most cases
More informationFinancial Disclosure. Prostaglandin Analogs (PGs) The Glaucoma Grab Bag: Practical Guidelines for Effective Glaucoma Therapy
The Glaucoma Grab Bag: Practical Guidelines for Effective Glaucoma Therapy Danica J. Marrelli, OD, FAAO University of Houston College of Optometry Financial Disclosure I have received I have received speaking
More informationManaging the Patient with POAG
Managing the Patient with POAG Vision Institute Annual Fall Conference Mitchell W. Dul, OD, MS, FAAO mdul@sunyopt.edu Richard J. Madonna, MA, OD, FAAO rmadonna@sunyopt.edu Ocular Hypertension (OHT) Most
More informationGet a grip on your glaucoma Booklet 1
Information for Patients Glaucoma services Welcome! Get a grip on your glaucoma Booklet 1 Group-based Glaucoma information Course Session 1 What happens in session 1? Finding out what questions you have
More informationTreatments for Open-Angle Glaucoma. A Review of the Research for Adults
Treatments for Open-Angle Glaucoma A Review of the Research for Adults Is This Information Right for Me? Yes, this information is for you if: Your eye doctor has said that you have open-angle glaucoma,
More informationVI.2.2 Summary of treatment benefits
EU-Risk Management Plan for Bimatoprost V01 aetiology), both OAG and ACG can be secondary conditions. Secondary glaucoma refers to any case in which another disorder (e.g. injury, inflammation, vascular
More informationBNF CHAPTER 11: EYE 1 January 2018
BNF CHAPTER 11: EYE 1 BNF 11.3.1 ANTIBACTERIALS First Choice. Broad spectrum. Chloramphenicol 0.5% Eye Drops Administration Alternative Administration Eye drops, apply 1 drop at least every 2 hours then
More informationVision Health: Conditions, Disorders & Treatments GLAUCOMA
Vision Health: Conditions, Disorders & Treatments GLAUCOMA Glaucoma is a disease of the optic nerve, which transmits the images you see from the eye to the brain. The optic nerve is made up of many nerve
More informationPGAs. Glaucoma Pharmacology A-Z. Selecting Therapy. PGAs Prostaglandin analogs. Prostaglandin Side Effects 1/6/2014
PGAs Glaucoma Pharmacology A-Z Eric E. Schmidt, O.D. Omni Eye Specialists Wilmington, NC schmidtyvision@msn.com QHS dosing Long duration of action Flatten diurnal curve Effective on trough and peak IOP
More informationBrightFocus Foundation is the new name for American Health Assistance Foundation.
In this section, you will find the following: Glaucoma Medications Laser Therapies Conventional Surgical Procedures In the second section, you will find information on how to search for potential treatments
More informationDeveloped by Ipswich Hospital NHS Trust and Ipswich and East Suffolk Clinical Commissioning Group. Joint formulary - Ophthalmology
Developed by Ipswich Hospital NHS Trust and Ipswich and East Suffolk Clinical Commissioning Group. Document type and title: Joint formulary - Ophthalmology Authorised document folder: New or replacing
More informationAbbreviated Update: Ophthalmic Glaucoma Agents
Drug Use Research & Management Program Oregon State University, 500 Summer Street NE, E35, Salem, Oregon 97301-1079 Phone 503-945-5220 Fax 503-947-1119 Abbreviated Update: Ophthalmic Glaucoma Agents Month/Year
More informationLong Term Care Formulary RS 14. RESTRICTED STATUS Topical Medical Treatment of Glaucoma 1 of 5
RESTRICTED STATUS Topical Medical Treatment of Glaucoma 1 of 5 PREAMBLE Significance: Glaucoma occurs in 1-2% of white people aged over 40 years, rising to 5% at 70 years and exponentially with advancing
More informationVolume 9; Number 3 March 2015 PRESCRIBING AND DISPENSING PREGABALIN FOR NEUROPATHIC PAIN
Arden and Greater East Midlands Commissioning Support Unit in association with Lincolnshire Clinical Commissioning Groups, Lincolnshire Community Health Services, United Lincolnshire Hospitals Trust and
More informationIOP measurements: 8.00 am (trough drug levels) and am (peak drug levels)(2 hours post dose)
This overview of 2% eye drops was presented by Dr. Ravin N. Das, at Hotel Satya Ashoka, on 19-6-2004 in place of Dr. H. S. Ray due to unforseen circumstances. This dinner meeting was sponsored by Cipla
More information11 Eye. regarding this product in this setting. As a result we cannot recommend its use within NHSScotland.
Recommendations from the Lothian Formulary Committee (FC) following Scottish Medicines Consortium (SMC) advice, NICE MTA advice, (FAF3) unlicensed and off-label medicines and (FAF2) medicines not considered
More informationGlaucoma Disease Progression Role of Intra Ocular Pressure. Is Good Enough, Low Enough?
Glaucoma Disease Progression Role of Intra Ocular Pressure Is Good Enough, Low Enough? Glaucoma Diseases Progression Key Considerations Good number of patients may be diagnosed only after some damage the
More informationElements for a Public Summary. Overview of disease epidemiology
VI.2 VI.2.1 Elements for a Public Summary Overview of disease epidemiology Epidemiology of the disease Incidence and prevalence Increased pressure in the eye occurs in more than 100 million people, and
More informationA. Incorrect! Acetazolamide is a carbonic anhydrase inhibitor given orally or by intravenous injection.
Pharmacology - Problem Drill 20: Drugs that Treat Glaucoma Question No. 1 of 10 1. is a topical carbonic anhydrase inhibitor. Question #01 (A) Acetazolamide (B) Clonidine (C) Dorzolamide (D) Apraclonidine
More informationGlaucoma is a heterogeneous
Old and New Drug Classes Expanding To Include Glaucoma Treatments Troy Kish, PharmD, BCPS Glaucoma is a heterogeneous disease characterized by the development of increased intraocular pressure (IOP) that
More information11.Eye Administration of drugs to the eye. Eye drops. Eye ointments. Prescribing of Unlicensed Eye Products
1 11.Eye 11.1 - Administration of drugs to the eye Eye-drop dispenser devices (Compleye, Opticare, Opticare Arthro 5, Opticare Arthro 10) are available to aid the instillation of eye drops from plastic
More informationNational Institute for Health and Clinical Excellence. Glaucoma. Guideline Consultation Comments Table. 29 September November 2008
National Institute for Health and Clinical Excellence Glaucoma Guideline Consultation Comments Table 29 September 2008 24 November 2008 Stat us Organisa tion Order no. Version Page no Line no/se ction
More information11.Eye Administration of drugs to the eye. Eye drops. Eye ointments. Prescribing of Unlicensed Eye Products
1 11.Eye 11.1 - Administration of drugs to the eye Eye-drop dispenser devices (Compleye, Opticare, Opticare Arthro 5, Opticare Arthro 10) are available to aid the instillation of eye drops from plastic
More informationVolume 11; Number 5 February 2017 REVIEW OF GONADOTROPIN RELEASING HORMONE AGONISTS FOR PROSTATE CANCER (REVISED EDITION)
Optum in association with Lincolnshire Clinical Commissioning Groups, Lincolnshire Community Health Services, United Lincolnshire Hospitals Trust and Lincolnshire Partnership Foundation Trust Volume 11;
More information[TRAVOPROST] 40 MICROGRAMS/ML, EYE DROPS, SOLUTION RISK MANAGEMENT PLAN. TRAVOPR-v
[TRAVOPROST] 40 MICROGRAMS/ML, EYE DROPS, SOLUTION RISK MANAGEMENT PLAN TRAVOPR-v2-270214 VI.2 Elements for a public summary VI.2.1 Overview of disease epidemiology Studies estimated that 3-6 million people
More informationVolume 6; Number 1 January 2012 NICE CLINICAL GUIDELINE 127: HYPERTENSION CLINICAL MANAGEMENT OF PRIMARY HYPERTENSION IN ADULTS (AUGUST 2011)
Volume 6; Number 1 January 2012 NICE CLINICAL GUIDELINE 127: HYPERTENSION CLINICAL MANAGEMENT OF PRIMARY HYPERTENSION IN ADULTS (AUGUST 2011) What s new in hypertension? NICE has issued an updated Clinical
More information11 Eye. systemic disease or both eyes are affected (or 1 eye is affected if the second eye has poor visual acuity) and
Recommendations from the Lothian Formulary Committee (FC) following Scottish Medicines Consortium (SMC) advice, NICE MTA advice, (FAF3) unlicensed and off-label medicines and (FAF2) medicines not considered
More informationClass Update with New Drug Evaluation: Glaucoma Drugs
Class Update with New Drug Evaluation: Glaucoma Drugs Date of Review: May 2018 Date of Last Review: January 2015 End Date of Literature Search: 02/26/2018 Generic Name: latanoprostene bunod Brand Name
More informationSummary of the risk management plan (RMP) for Izba (travoprost)
EMA/14138/2014 Summary of the risk management plan (RMP) for Izba (travoprost) This is a summary of the risk management plan (RMP) for Izba, which details the measures to be taken in order to ensure that
More informationAbbreviated Class Update: Ophthalmics, Glaucoma agents. Month/Year of Review: August 2012 End date of literature search: June 2012
Copyright 2012 Oregon State University. All Rights Reserved Drug Use Research & Management Program Oregon State University, 500 Summer Street NE, E35, Salem, Oregon 97301-1079 Phone 503-947-5220 Fax 503-947-1119
More informationUpdate on Rhopressa TM QD (netarsudil ophthalmic solution) 0.02% and Roclatan TM (netarsudil/latanoprost ophthalmic solution) 0.02%/0.
Update on Rhopressa TM QD (netarsudil ophthalmic solution) 0.02% and Roclatan TM (netarsudil/latanoprost ophthalmic solution) 0.02%/0.005% 1 Important Information Any discussion of the potential use or
More informationVolume 7; Number 17 October 2013
Greater East Midlands Commissioning Support Unit in association with Lincolnshire Clinical Commissioning Groups, Lincolnshire Community Health Services, United Lincolnshire Hospitals Trust and Lincolnshire
More informationClass Update with New Drug Evaluation: Glaucoma Drugs
Copyright 2012 Oregon State University. All Rights Reserved Drug Use Research & Management Program Oregon State University, 500 Summer Street NE, E35 Salem, Oregon 97301-1079 Phone 503-947-5220 Fax 503-947-1119
More informationLincolnshire Prescribing and Clinical Effectiveness Bulletin
S Lincolnshire Prescribing and Clinical Effectiveness Bulletin Volume 12 No 10, November 2018 Optum in association with Lincolnshire Clinical Commissioning Groups, Lincolnshire Community Health Services,
More informationOCULAR PHARMACOLOGY GLAUCOMA. increased intraocular pressure. normally mm Hg. when to Tx no fixed level.
OCULAR PHARMACOLOGY GLAUCOMA increased intraocular pressure normally 12 20 mm Hg. when to Tx no fixed level. literature sets ~21 mm Hg as upper limit of normal. some safe at 30 mm Hg some may have damage
More informationReason for Unscheduled Visit
Page 1 of 7 OHUN16.01 MULE: UNREASONS Reason for Unscheduled Visit * On any given page, any section started should be completed. Check all that apply: 1. Confirmation of IOP... Complete Snellen, IOP, Ocular
More informationElements for a public summary. Overview of disease epidemiology
VI.2 VI.2.1 Elements for a public summary Overview of disease epidemiology Glaucoma is an eye disease that can result in damage to the optic nerve and loss of vision (blindness). It is the major cause
More informationGlaucoma: diagnosis and management (large print version)
Glaucoma: diagnosis and management (large print version) 1 November 2017 Recommendations People have the right to be involved in discussions and make informed decisions about their care, as described in
More informationGLAUCOMA (2006) PHILIPPINE GLAUCOMA SOCIETY
GLAUCOMA (2006) PHILIPPINE GLAUCOMA SOCIETY CPM 9 TH EDITION Philippine Glaucoma Society (PGS) Correspondence to: Eye Referral Center, T. M. Kalaw Street, Ermita, Manila Telephone: 524-7119/525-9360 Mobile:
More informationVolume 8; Number 13 July 2014
Greater East Midlands Commissioning Support Unit in association with Lincolnshire Clinical Commissioning Groups, Lincolnshire Community Health Services, United Lincolnshire Hospitals Trust and Lincolnshire
More informationClass Update: Ophthalmic Glaucoma Agents
Drug Use Research & Management Program Oregon State University, 500 Summer Street NE, E35, Salem, Oregon 97301-1079 Phone 503-945-5220 Fax 503-947-1119 Class Update: Ophthalmic Glaucoma Agents Month/Year
More informationTrends In The Utilization of Antiglaucoma Medication: An Analysis of Canadian Drug Insurance Claims
Western University Scholarship@Western Electronic Thesis and Dissertation Repository April 2014 Trends In The Utilization of Antiglaucoma Medication: An Analysis of Canadian Drug Insurance Claims Kwun
More informationROBERT L. SHIELDS, M.D. GLAUCOMA SURGERY AND TREATMENT
1 CURRICULUM VITAE ROBERT L. SHIELDS, M.D. GLAUCOMA SURGERY AND TREATMENT University of Colorado Health Eye Center Cherry Creek 2000 South Colorado Boulevard Annex Building, Suite 100 Denver, Colorado
More informationCollaboration in the care of glaucoma patients and glaucoma suspects. Barry Emara MD FRCS(C) Nico Ristorante November 29, 2012
Collaboration in the care of glaucoma patients and glaucoma suspects Barry Emara MD FRCS(C) Nico Ristorante November 29, 2012 Goals of Collaboration Patient-centred and evidence based approach Timely access
More informationElements for a public summary. VI.2.1 Overview of disease epidemiology
VI.2 Elements for a public summary VI.2.1 Overview of disease epidemiology Studies estimated that 3-6 million people in the United States alone, including 4-10% of the population older than 40 years, have
More informationGlaucoma/OHT in the Community Suspect Investigation & Stable Management
Glaucoma/OHT in the Community Suspect Investigation & Stable Management Provider Training 24-01-19 BHR 06-02-19 Wilts Stable patients available from 28 th Jan Christian Dutton Clinical Optometrist BSc(Hons.)
More informationPrimary open-angle glaucoma By Dr Luke Bereznicki
Primary open-angle glaucoma By Dr Luke Bereznicki Case study Mabel, a regular customer, asks for advice about the different medications used in the treatment of glaucoma. She was diagnosed with glaucoma
More informationKEY MESSAGES. Details of the evidence supporting these recommendations can be found in the above CPG, available on the following websites:
QUICK REFERENCE FOR HEALTHCARE PROVIDERS KEY MESSAGES 1. Glaucoma is a chronic eye disease that damages the optic nerve, & can result in serious vision loss and irreversible blindness. 2. Glaucoma diagnosis
More informationLOWPROST Eye Drops (Bimatoprost Ophthalmic Solution 0.01%)
Published on: 14 Apr 2017 LOWPROST Eye Drops (Bimatoprost Ophthalmic Solution 0.01%) For the use of a Registered Medical Practitioner or a Hospital or a Laboratory only Composition Each ml contains: Bimatoprost...
More informationGlaucoma: target intraocular pressures and current treatments James McAllister FRCS, FRCOphth
Glaucoma: target intraocular pressures and current treatments James McAllister FRCS, FRCOphth Skyline Imaging Ltd Our Drug review of glaucoma management describes the use of target intraocular pressures
More informationLincolnshire Prescribing and Clinical Effectiveness Bulletin
S Lincolnshire Prescribing and Clinical Effectiveness Bulletin Volume 11 No 12, September 2017 Optum in association with Lincolnshire Clinical Commissioning Groups, Lincolnshire Community Health Services,
More informationGlaucoma Pharmacology A-Z
GLAUCOMA PHARMACOLOGY A-Z ERIC E. SCHMIDT, O.D., F.A.A.O. Building-block approach to medical therapy Establish the strongest foundation prior to resorting to adjunctive therapy OMNI EYE SPECIALISTS WILMINGTON,
More informationCompleted Clinical Research Trials Monte Dirks, M.D.
Completed Clinical Research Trials Monte Dirks, M.D. Monte Dirks, M.D. - Primary Investigator Norfloxacin -Merck (1986) Safety and efficacy of norfloxacin vs. tobramycin in the treatment of external ocular
More informationVisit Type (Check one)
Page 1 of 14 OHFV21.01 MULE: Page 1 Visit Type (Check one) Visit prior to 078 month visit enter visit window 0 Semi-Annual: Annual: 078 mo. 090 mo. 102 mo. 114 mo. 126 mo. 138 mo. 150 mo. 162 mo. 084 mo.
More informationPRACTICAL APPROACH TO MEDICAL MANAGEMENT OF GLAUCOMA
PRACTICAL APPROACH TO MEDICAL MANAGEMENT OF GLAUCOMA DR. RAVI THOMAS, DR. RAJUL PARIKH, DR. SHEFALI PARIKH IJO MAY 2008 PRESENTER AT JDOS : DR. RAHUL SHUKLA T.N. SHUKLA EYE HOSPITAL TERMINOLOGY POAG: PRIMARY
More informationOriginal Article. Abstract. Introduction. C Olali, G Malietzis, S Ahmed, E Samaila 1, M Gupta
Original Article Real-life experience study of the safety and efficacy of travoprost 0.004% / timoptol 0.50% fixed combination ophthalmic solution in intraocular pressure control C Olali, G Malietzis,
More informationNICE guideline Published: 1 November 2017 nice.org.uk/guidance/ng81
Glaucoma: diagnosis and management NICE guideline Published: 1 November 2017 nice.org.uk/guidance/ng81 NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-ofrights).
More informationChronic eye diseases. Title of section divider. What s new, and how GPs can help. Eg. Case Study 1. Dr Jesse Gale, ophthalmologist
Chronic eye diseases Title of section divider What s new, and how GPs can help Eg. Case Study 1. Dr Jesse Gale, ophthalmologist 1 Title of section divider Cataract Eg. Case Study 1. 2 Cataract - what s
More informationBETAGAN Allergan Levobunolol HCl Glaucoma Therapy
BETAGAN Allergan Levobunolol HCl Glaucoma Therapy Action And Clinical Pharmacology: Levobunolol is a noncardioselective beta- adrenoceptor antagonist, equipotent at both beta1 and beta2 receptors. Levobunolol
More informationEXAMINING PATIENT-PHYSICIAN COMMUNICATION REGARDING COST IN THE GLAUCOMA PATIENT POPULATION
EXAMINING PATIENT-PHYSICIAN COMMUNICATION REGARDING COST IN THE GLAUCOMA PATIENT POPULATION Catherine Slota A dissertation submitted to the faculty at the University of North Carolina at Chapel Hill in
More information3/31/2019. Role of IOP. Role of IOP. Role of IOP. Role of IOP. Evaluation of glaucoma has changed Why hasn t treatment?
Glaucoma Update ROLE FOR RHOPRESSA Gregory D. Searcy, M.D. 1857: German ophthalmologist Albrecht Van Graefe concluded all glaucomatous optic disc excavation is associated with high IOP based on the only
More informationMedical Treatment in Pediatric Glaucoma
Medical Treatment in Pediatric Glaucoma By Nader Bayoumi, MD Lecturer of Ophthalmology Ophthalmology Department Alexandria University Alexandria, Egypt ESG 2012 Pediatric glaucoma is a surgical disease
More informationBuilding a Major Ophthalmic Pharmaceutical Company. Aerie Pharmaceuticals, Inc. Company Overview June 2-3, 2015
Building a Major Ophthalmic Pharmaceutical Company Aerie Pharmaceuticals, Inc. Company Overview June 2-3, 2015 1 Important Information Any discussion of the potential use or expected success of our product
More informationRecent advances in the diagnosis and management of glaucoma
DRUG REVIEW n Recent advances in the diagnosis and management of glaucoma Parham Azarbod BSc, MRCS, FRCOphth, Laura Crawley BSc, MRCP, FRCOphth, Faisal Ahmed FRCOphth, M Francesca Cordeiro PhD, MRCP, FRCOphth,
More informationVolume 10; Number 10 July 2016
Arden and Greater East Midlands Commissioning Support Unit in association with Lincolnshire Clinical Commissioning Groups, Lincolnshire Community Health Services, United Lincolnshire Hospitals Trust and
More informationAPPROVED PACKAGE INSERT FOR XALATAN EYE DROPS. Each millilitre contains latanoprost 50 µg and benzalkonium chloride 0,02 % m/v as preservative.
SCHEDULING STATUS: S4 APPROVED PACKAGE INSERT FOR XALATAN EYE DROPS PROPRIETARY NAME (and dosage form): XALATAN Eye Drops COMPOSITION: Each millilitre contains latanoprost 50 µg and benzalkonium chloride
More informationANNEX I SUMMARY OF PRODUCT CHARACTERISTICS
ANNEX I SUMMARY OF PRODUCT CHARACTERISTICS 1 1. NAME OF THE MEDICINAL PRODUCT LUMIGAN 0.1 mg/ml eye drops, solution 2. QUALITATIVE AND QUANTITATIVE COMPOSITION One ml of solution contains 0.1 mg bimatoprost.
More informationDrug Prescribing Pattern & Adverse Drug Effects Of Anti Glaucoma Medication for Primary Glaucoma at Tertiary Care Hospital
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861.Volume 16, Issue 11 Ver. III (Nov. 2017), PP 36-41 www.iosrjournals.org Drug Prescribing Pattern & Adverse Drug
More information5/12/2014. Lynn E. Lawrence, CPOT, ABOC, COA
Lynn E. Lawrence, CPOT, ABOC, COA Glaucoma is an optic neuropathy characterized by a loss of ganglion cells and their axons, in the RNFL. The loss of retinal ganglion cells in glaucoma is irreversible
More informationIt is estimated that within our
Continuing education CET Medical co-management of glaucoma Greater emphasis is being put on suitably trained optometrists to play a greater role in managing glaucoma. Aachal Kotecha and Alexander Spratt
More informationA complicated groups of disorders characterized by optic disc and v. field changes related to a high or a statically normal IOP. It involves a study
THE GLAUCOMAS A complicated groups of disorders characterized by optic disc and v. field changes related to a high or a statically normal IOP. It involves a study of (1) IOP(2) ON head changes (3) V.field
More informationVolume 8; Number 4 February 2014
Greater East Midlands Commissioning Support Unit in association with Lincolnshire Clinical Commissioning Groups, Lincolnshire Community Health Services, United Lincolnshire Hospitals Trust and Lincolnshire
More informationClass Update with New Drug Evaluation: Glaucoma Drugs
Copyright 2012 Oregon State University. All Rights Reserved Drug Use Research & Management Program Oregon State University, 500 Summer Street NE, E35 Salem, Oregon 97301-1079 Phone 503-947-5220 Fax 503-947-1119
More informationNATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE SCOPE. Glaucoma: diagnosis and management of chronic open angle glaucoma and ocular hypertension
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE 1 Guideline title SCOPE Glaucoma: diagnosis and management of chronic open angle glaucoma and ocular hypertension 1.1 Short title Glaucoma 2 Background
More informationIMPROVING ADHERENCE IN GLAUCOMA
IMPROVING ADHERENCE IN GLAUCOMA A MANUAL FOR PHARMACISTS Eden Simon, Ivan Goldberg, Jonathan Penm, Geoff Pollard & Shalom Benrimoj 1 Authors Eden Simon, B.MedSc, M.Pharm Ivan Goldberg AM, MBBS (Syd), FRANZCO,
More informationElements for a public summary. VI.2.1 Overview of disease epidemiology
VI.2 Elements for a public summary VI.2.1 Overview of disease epidemiology The term ocular hypertension usually refers to any situation in which the pressure inside the eye, called intraocular pressure,
More informationDeveloped By Name Signature Date
Patient Group Direction 2156 version 2.0 Administration of Ipratropium 250mcg/ml Nebuliser Solution in Acute Asthma by Registered Practitioners employed by Torbay and South Devon NHS Foundation Date of
More informationXalatan and Xalatan /betablocker fixed combination : role in glaucoma therapy
Xalatan and Xalatan /betablocker fixed combination : role in glaucoma therapy Grant McLaren St John Eye Hospital Division of Ophthalmology University of Witwatersrand Johannesburg South Africa 1 Goals
More informationNEW ZEALAND DATA SHEET
TRUSOPT 2% Ophthalmic Solution dorzolamide hydrochloride 1 Trusopt 2% Opthalmic Solution 2 QUALITATIVE AND QUANTITATIVE COMPOSITION Each 1mL of TRUSOPT 2% contains 20 mg dorzolamide (22.3 mg of dorzolamide
More informationDrugs for glaucoma. Ivan Goldberg, Eye Associates and Glaucoma Service, Sydney Eye Hospital and the Save Sight Institute, University of Sydney, Sydney
Drugs for glaucoma Ivan Goldberg, Eye Associates and Glaucoma Service, Sydney Eye Hospital and the Save Sight Institute, University of Sydney, Sydney SYNOPSIS Older drugs for glaucoma reduce intra-ocular
More informationDATA SHEET. Clinical studies have shown mean intraocular pressure decreases of up to 9 mmhg.
DATA SHEET NAME OF MEDICINE LUMIGAN (bimatoprost) 0.3 mg/ml eye drops Presentation LUMIGAN (bimatoprost) eye drops are a clear, isotonic, colourless, sterile ophthalmic solution. Bimatoprost is a white
More informationDivakar Gupta Glaucoma Fellow, Duke Eye Center 5/14/16
Divakar Gupta Glaucoma Fellow, Duke Eye Center 5/14/16 Pathophysiology of glaucoma Consider risk factors of glaucoma Understand the side effects of glaucoma medications Diagnostic testing Leading cause
More informationPatients with ocular hypertension or
... REPORTS... An Economic Analysis of Switching to Latanoprost from a β-blocker or Adding Brimonidine or Latanoprost to a β-blocker in Open-Angle Glaucoma or Ocular Hypertension William C. Stewart, MD;
More informationGlaucoma: what should the general practitioner know?
Glaucoma: what should the general practitioner know? Abstract Labuschagne MJ, MBChB, MMed(Ophth)(UFS) Department of Ophthalmology (M1), School of Medicine, Faculty of Health Sciences, University of the
More informationGlaucoma Clinical Update. Barry Emara MD FRCS(C) Giovanni Caboto Club October 3, 2012
Glaucoma Clinical Update Barry Emara MD FRCS(C) Giovanni Caboto Club October 3, 2012 Objectives Understand the different categories of glaucoma Recognize the symptoms and signs of open angle and angle-closure
More informationPreservative-Free Tafluprost % in the Treatment of Patients with Glaucoma and Ocular Hypertension
Adv Ther (211) 28(7):575-585. DOI 1.17/s12325-11-38-9 ORIGINAL RESEARCH Preservative-Free Tafluprost.15% in the Treatment of Patients with Glaucoma and Ocular Hypertension Carl Erb Ines Lanzl Seid-Fatima
More informationEconomic Evaluation of Ophthalmic Solutions for Glaucoma Treatment Including Consideration of Clinical Efficacy
Regular Article Jpn J Pharm Health Care Sci 40(9) 500 506 (2014) Economic Evaluation of Ophthalmic Solutions for Glaucoma Treatment Including Consideration of Clinical Efficacy Takashi Tomita 1, Hiroaki
More informationVolume 4; Number 5 May 2010
Volume 4; Number 5 May 2010 CLINICAL GUIDELINES FOR ANTIDEPRESSANT USE IN PRIMARY AND SECONDARY CARE Lincolnshire Partnership Foundation Trust in conjunction with Lincolnshire PACEF have recently updated
More informationSHARED CARE GUIDELINE: Mycophenolate mofetil or mycophenolic acid for Maintenance of Immunosuppression after Kidney Transplantation in Adults
NHS LINCOLNSHIRE in association with UNITED LINCOLNSHIRE HOSPITALS TRUST SHARED CARE GUIDELINE: Mycophenolate mofetil or mycophenolic acid for Maintenance of Immunosuppression after Kidney Transplantation
More informationM Diestelhorst, L-I Larsson,* for The European Latanoprost Fixed Combination Study Group...
199 SCIENTIFIC REPORT A 12 week study comparing the fixed combination of latanoprost and timolol with the concomitant use of the individual components in patients with open angle glaucoma and ocular hypertension
More informationPATIENT INFORMATION LEAFLET
Page 1 PATIENT INFORMATION LEAFLET Please read this leaflet carefully before using COMBIGAN. Keep this leaflet. You may need to read it again. If you have any further questions, please ask your doctor
More informationSUMMARY OF PRODUCT CHARACTERISTICS
Page 1/9 SUMMARY OF PRODUCT CHARACTERISTICS 1. NAME OF THE MEDICINAL PRODUCT 2. QUALITATIVE AND QUANTITATIVE COMPOSITION One ml of solution contains 0.3 mg bimatoprost. One drop contains approximately
More informationLipid Lowering in patients with High Risk of Cardiovascular Disease (Primary Prevention)
Lipid Lowering in patients with High Risk of Cardiovascular Disease (Primary Prevention) Policy Statement: October 2010 This policy defines the decision made by NHS Wirral following an evidence review
More informationCOMPARISON OF IOP LOWERING EFFICACY BRIMONIDINE-TIMOLOL VERSUS DORZOLAMIDE-TIMOLOL FIXED COMBINATION THERAPY
COMPARISON OF IOP LOWERING EFFICACY BRIMONIDINE-TIMOLOL VERSUS DORZOLAMIDE-TIMOLOL FIXED COMBINATION THERAPY DR. HIDAYATULLA KHAN, M.S. (Ophthalmology) SILVER CRESCENT EYE HOSPITAL Noorkhan Bazar, Hyderabad
More informationGlaucoma. Glaucoma. Glaucoma. Trevor Arnold, MS, DVM, DACVO
Glaucoma Trevor Arnold, MS, DVM, DACVO Glaucoma Physiology of Aqueous Humor Produced in the ciliary body Flows out the iridocorneal angle and ciliary cleft High intraocular pressures are caused by a decreased
More informationShared Care Guidance. Vigabatrin
North of Tyne Area Prescribing Committee Shared Care Guidance Vigabatrin July 2014 (Review date July 2016) This guidance has been prepared and approved for use in Newcastle, North Tyneside and Northumberland.
More information